Health Is Wealth: The Latest on Alternative Payment Models BY S A N J AY D O D DA M A N I , M D , S T E V E N EO R R , A N D VA L I N DA R U T L E D G E
As Americans emerge from the pandemic, there is heightened awareness of the importance of having adequate healthcare coverage, managing out-of-pocket costs, and recognizing how risk factors play into surviving an illness. It is also vital to preserve access to ongoing care for chronic conditions and acute care for emergencies. Both chronic and acute care were impacted by the pandemic:
Sanjay Doddamani, MD
• In the early phase, death rates were higher for acute events when patients avoided hospitals for strokes and heart attacks. • By failing to control chronic conditions, patients who missed testing and preventive care experienced worse health outcomes.
“Physician, heal
thyself, brings new meaning by embracing payment reform, delivery reform, and digital transformation.”
• Primary care physicians whose sole revenue was fee-for-service experienced adverse financial impact in 2020. • Meanwhile, payers showed record earnings during the same period.
Steve Neorr
Both patients and physicians can agree that the current payment model does little to provide value or patient experience commensurate to the level of healthcare spending. So what comes next? As a professional association with more than 350 medical groups, health systems, and independent practice associations accustomed to bearing substantial financial risk, America’s Physician Groups (APG) members have been leading participants in alternative payment models (APMs) for years. APG has a dedicated APM Committee that addresses payment model options and facilitates discussion and sharing of best practices by national experts. The idea is to further the development of APMs—including accountable care organizations (ACOs), medical homes, and bundled payments—across all payers.
Valinda Rutledge
The committee’s discussions cover a wide range of topics but mostly revolve around three areas: payment reform, delivery reform, and digital transformation. Below is a look at some of our discussions over the past year with several national experts.
1. PAYMENT REFORM David Muhlestein, PhD, JD, Chief Research Officer at Leavitt Partners, a leading healthcare consulting firm, spoke at our March 23 committee meeting. Dr. 34 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS
Spring 2021
